Demande directe (CEACR) - adoptée 2013, publiée 103ème session CIT (2014)

Convention (n° 24) sur l'assurance-maladie (industrie), 1927 - Colombie (Ratification: 1933)

Article 4(1) of the Convention. Minimum periods of contribution required for entitlement to medical care. The Committee takes note that, pursuant to article 61(2) of Decree No. 806 of 1998, a contributing member who is not in a financial position to pay the established percentage and who has proved his or her situation to the institution must, along with his or her beneficiaries, be given treatment by the public health service institutions, or by private institutions with which the State has a contractual arrangement. The said institutions may charge a corresponding fee.

The Single Confederation of Workers of Colombia (CUT) states that, under the current compulsory health plan (POS), during the first four weeks of contribution insured persons are entitled to emergency treatment, maternity care, treatment for a newborn child and promotional and preventive services; between four and 26 weeks they are entitled to general and specialized medical consultations (the patient must be referred to a specialist by the general practitioner), to laboratory tests and diagnostic assistance, to such medication as is covered by the health plan and to hospitalization and low-complexity surgery; after 26 weeks they are entitled to hospitalization and medium-complexity surgery and to treatment for serious or high-cost illness.

Article 4(2). Participation in the cost of medical care. The Committee also takes note that, pursuant to article 61(1) of the aforementioned Decree, insured persons bound by minimum periods of contribution who wish to receive treatment before the stipulated minimum period (26 weeks) must pay a percentage of the total value of the treatment corresponding to the percentage in weekly contributions that remain before they have completed the minimum period.

The Committee takes note of this information and of the fact that all workers are entitled to medical treatment from the first day they are insured, including workers who do not have sufficient financial means to pay the medical costs. The Committee requests the Government to send it statistical data on the number of workers who have been unable to pay the stipulated percentage, the number of workers who have paid a percentage of the total cost of the treatment, and the total amount paid in respect of these categories of beneficiaries.

Article 6(1). Non-profit-making and profit-making sickness insurance institutions. Regarding the proportion of workers covered by public health-care providers (EPS) compared to members of private providers, the Government states that the system has 23 health-care providers, two of which are public and provide medical services and treatment to 0.38 per cent of the total number of contributors covered. The CUT states that, since the adoption of Act No. 100 of 1993, the private sector has been gaining a lot of ground and today not a single health-care provider belongs entirely to the State. It adds that Act No. 1151 of 2007 authorized the entry of private capital into the one remaining public provider, thus creating a new health-care provider which, although the State maintains a share in it, is mostly funded by private capital. In practice, the proportion of workers covered by public providers is virtually nil. However, bearing in mind that almost half of the new health-care provider is funded by state capital, the proportion in terms of membership was 13.7 per cent in 2011.

Regarding the protection of workers against contingencies covered by profit making health insurance companies, the Government states that machinery exists at the community level for monitoring the system; these are management, monitoring and control bodies and administration and financing bodies (Ministry of Labour, Ministry of Health and Social Welfare, the Regulatory Health Committee, national health and finance departments, health promotion bodies, section, district and local health departments and the Solidarity and Guarantee Fund). In addition, the system recommends that the various agents be consulted at every level through national, district and municipal social security health councils and establishes mechanisms for monitoring the health services so as to guarantee that their users receive quality treatment that is appropriate, personalized, human, comprehensive and permanent, in accordance with the accepted standards of professional procedures and practices. On this point, the CUT notes that there is a conflict between the provision of adequate services and the profit-making nature of the health-care providers, which are known to have as far as possible prevented the affiliation of population groups that have traditionally been discriminated against and groups that are manifestly vulnerable. In addition to legislative restrictions, insured persons have to contend with the administrative obstacles posed by the system’s various bodies which hamper their effective enjoyment of the right to health. The Committee recalls that, under the terms of the Convention, sickness insurance must be administered by self-governing institutions that may not be operated with a view to profit, so as to prevent their skimping on the services they provide for reasons other than the beneficiaries’ health. The Committee requests the Government to provide information on the activities of the management bodies and of the national, district and municipal social security health councils that monitor the services to users; for example, in the form of reports on inspections, on the penalties for infringing the regulations and on the number of complaints concerning the quality of the services.

Article 6(2). Participation of insured persons in management. The Government states that, pursuant to Decree No. 1018 of 2007, the National Health Department encourages public involvement and oversight and the establishment of associations, leagues or alliances of users of the health-care providers’ services. The presence of representatives of the user community on the executive boards of public institutions is compulsory. Moreover, regarding the participation of insured persons in the executive boards of private health-care providers, article 14(3) of Decree No. 1757 of 1994 stipulates that such participation must be in accordance with the legal provisions on the matter. The National Health Department has, with the Ministry of Health and Social Welfare, been engaging in consultations on the drafting of regulations laying down the conditions and requirements that private health-care providers must adopt as part of their statutes and rules so that users may participate in the management of the private health-care providers. The CUT notes that the State has not developed any machinery for guaranteeing direct participation by the most representative organizations. The Committee requests the Government to indicate the number of associations, leagues or alliances that are currently operating within the health-care providers, as well as the conditions and requirements that the latter must adopt as part of their statutes and rules so that the users can participate in such bodies. The Committee also requests the Government to keep it informed of the outcome of the consultations carried out and of any rules and regulations on the subject.

The National Social Security Health Council (CNSSS) and the Health Regulation Committee (CRES). Regarding the function of the social partners within the CRES and their replacement by experts elected by users’ associations, the Government states that section 3 of Act No. 1122 of 2007 left it to the Ministry of Health and Social Welfare to regulate the function of the CNSSS advisory services. Since no such regulations were issued, the CNSSS was unable to function and the CRES was therefore not able to consult it. Section 3 was subsequently repealed and those functions of the Council that were not assigned to the CRES currently have no legal definition as they are not referred to in the legislation. The Committee notes that the functions of the CNSSS are now greatly reduced as most of them have been transferred to the CRES, which is no longer composed of the social partners but of experts appointed by the President. The Committee recalls that the Convention requires that the insured persons participate in the administration of self-governing insurance institutions. The Committee therefore once again requests the Government to indicate which users’ associations were chosen to propose the experts that make up the CRES and to clarify the current functions of the CNSSS vis-à-vis the CRES now that its advisory functions have been suspended. The Committee also requests the Government to take the necessary steps for regulations to be adopted that will restore the functions of the CNSSS and to keep the Office informed of developments.

Article 9. Appeal. In its earlier comments, the Committee requested the Government to inform it of the administrative channels of appeal available to insured persons in the event of objections to their right to benefits. On this point, the CUT states that legal appeals of a judicial and administrative nature have proved inefficient, mainly because of the authorities’ slowness in settling disputes with respect to the benefits provided under the general system. Consequently, these have been resolved through official requests for court protection or amparo, which have now have become the rule. Taking note of this information and of the fact that the Government has not provided the information it requested, the Committee again requests the Government to send all relevant information, together with information on the duration of proceedings with respect to the provision of services and on the number of requests for court protection or amparo that have been lodged in this connection.

Payment of health insurance – Intercontinental Aviation Company. In its previous request, the Committee requested the Government to indicate whether the employees of the Intercontinental Aviation Company had recovered their rights with respect to health insurance. The Government informs the Committee that the Ministry of Labour is conducting an inquiry and that a working group headed by the Vice-Minister of Labour Relations and Inspection has been set up to reach an agreement on the matter. The first meeting was held in June 2012 and another was scheduled for August 2012. The Committee takes note of this information and requests the Government to keep the Office informed of the outcome of the inquiry and of any agreement reached in this respect.